Hitting the books ... andAdderall Students pop stimulant to cram for finals

Some college students who stay up all night to cram for final exams are turning to prescription drugs such as Adderall to get what they can't from coffee, energy drinks and No-Doz alone: an energy boost, plus the ability to concentrate longer than their attention spans normally allow. Students who have tried Adderall, a stimulant prescribed for attention-deficit hyperactivity disorder, claim they can study for eight hours straight, write 30-page papers in one sitting, and somehow become engrossed in lectures they ordinarily find boring. The use of Adderall as a study aid is common during finals, according to more than two dozen students interviewed at three area colleges last week. Six of the students said they have used Adderall to help them study. More than half of the students said they knew someone who used it without a prescription. "Adderall, it's not hard to find," said Jill Diamond, a senior at Muhlenberg College in Allentown. "It's like four or five people you know probably have ADHD, so Adderall is everywhere." College health centers are aware of the latest twist on abuse of stimulants for ADHD, which began in the 1990s with the recreational use of Ritalin and has been fueled by thousands of students diagnosed for ADHD who are coming to campus with legal prescriptions. Brynnmarie Dorsey, Muhlenberg's director of health services, described the abuse of ADHD as "a growing trend affecting all college campuses." For people who don't have ADHD, Adderall produces a high, boosting their energy and concentration at first. But several hours later, energy levels will plummet, leaving users groggy and out-of-sorts. "If you don't have ADHD and you take a drug like Adderall or Ritalin, you are going to be anxious and jittery and sweaty," said Dr. Sarah Stevens, an adolescent medicine specialist in Allentown. "If you take it and you actually have depression, not ADHD, you are going to feel even more depressed." Health experts said Adderall and other stimulants such as Ritalin restore the balance of neurotransmitters in the brains of patients with ADHD, allowing them to calm down and concentrate. "It's a wonderful medicine, very safe" for people who truly need it, said Dr. Laurence Karper, a psychiatrist, director of substance abuse and emergency services, and vice chairman of inpatient services at Lehigh Valley Hospital-Muhlenberg. Karper and Stevens cautioned that improper use of stimulants can lead to dependency and addiction. It also can cause serious side effects, including hallucination, seizure and heart palpitations. "I don't like to scare people," Karper said. "Everyone knows someone who took the drug once or twice and was fine. But there's a reason these drugs are controlled substances." The U.S. Food and Drug Administration is reviewing the safety of drugs used to treat ADHD. An FDA advisory committee voted earlier this year to recommend that these drugs carry a "black box" label warning of increased risk of sudden death and serious cardiovascular problems. It's the strongest warning the FDA can apply. The FDA also called recently for stronger warnings for ADHD medications because of reports of psychosis or mania seen in some patients, especially younger children. Some students said any downsides to taking Adderall -- for some it's exhaustion or a racing heart -- were outweighed by the initial high and the increased attention span. They like Adderall better than Ritalin, Concerta and Dexedrine because they say it makes them feel less jittery. There is apparently little social stigma attached to taking controlled substances to do well on a test. And though it is not against the law to ingest Adderall, it is a crime to possess it without a prescription. Adderall is easy to come by. Friends, relatives and acquaintances who have prescriptions are more than willing to give up their pills as a favor or for quick cash, according to students interviewed at the three area colleges. The going rate seems to be $3 to $5 for 10- and 20-milligram pills -- more during finals time. The students say the carefree attitude on campus about popping a prescribed drug to study isn't surprising. They say they are part of a generation of students whose parents overscheduled them with after-school activities and had no reservations about getting them pills to calm their nerves, alleviate their depression or help them to sit still in school. More than 2.5 million children take stimulants for attention-deficit hyperactivity disorder, according to testimony heard by the FDA advisory committee that supported the black box warning. "It's the really overattentive parents," said Brittany Thompson, a Lehigh University senior from Weston, Conn. "It's like, 'There must be something wrong with my kid if she's not getting straight A's. So let's get her something to help her do better.' " Adderall abuse is following on the heels of illegal use of Ritalin. A decade ago, high schools and health experts began hearing reports of students stealing or buying Ritalin from students with ADHD. The user would crush and snort the drug to get high or lose weight. Schools now require parents to bring Ritalin prescriptions directly to school nurses, who dispense it to students. One study published last year in the Journal of American College Health found that 17 percent of men and 11 percent of women at a Midwestern university said they illegally used drugs intended for people with ADHD. Karper, the psychiatrist, said college health centers are too overwhelmed dealing with binge drinking and depression to address occasional amphetamine use that mostly occurs during exam periods. There's also been a rise in the number of parents seeking Adderall prescriptions for children struggling academically. It's hard for colleges to monitor stimulant abuse, partly because it is uncommon for students who use Adderall for the purposes of staying awake to overdose or seek treatment for addiction, said Dr. Margaret Spear, director of Penn State University Health Services. "It's hard to know exactly what is going on," Spear said. "Nobody really knows about it if a student uses it a couple times."